UHC Choice Plus Silver 4750-2

Health Insurance Plan Details (2024 Plan)

by UnitedHealthcare

Monthly Premium

POS
$ubsidy
Silver
Deductible
$4,750 /yr
Max Out-of-Pocket
$9,100 /yr

Details

Deductible (per individual) $4,750 /yr
Deductible (per family) $9,500 /yr
Max Out-of-Pocket (per individual) $9,100 /yr
Max Out-of-Pocket (per family) $18,200 /yr
Drug Deductible (per individual)
Drug Deductible (per family)
Drug Max Out-of-Pocket (per individual)
Drug Max Out-of-Pocket (per family)
Plan Type POS
Includes Child Dental? Yes
Includes Adult Dental? No
Medical Services
Preventive Care No Charge
Primary Care Visit $40 Copay
Specialist Visit $85 Copay
Emergency Room 30.00% Coinsurance after deductible
Inpatient Facility 30.00% Coinsurance after deductible
Inpatient Physician 30.00% Coinsurance after deductible
Drug Costs
Generic Drugs $15 Copay
Preferred Brand Drugs $60 Copay
Non-preferred Brand Drugs $150 Copay
Specialty Drugs $150 Copay

Plan Documents

Summary of Benefits and Coverage SBC doc
Provider Directory Doctor lookup
Drug Formulary List n/a

* Figures shown are only for in-network medical costs

** Please check with insurance company if Copay and Coinsurance rates are before or after the deductible


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